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Wang T, Li Y, Zheng X. Association of socioeconomic status with cardiovascular disease and cardiovascular risk factors: a systematic review and meta-analysis. ZEITSCHRIFT FUR GESUNDHEITSWISSENSCHAFTEN = JOURNAL OF PUBLIC HEALTH 2023:1-15. [PMID: 36714072 PMCID: PMC9867543 DOI: 10.1007/s10389-023-01825-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Accepted: 01/08/2023] [Indexed: 01/22/2023]
Abstract
Aim Cardiovascular disease (CVD) remains one of the leading causes of mortality worldwide, and several studies have indicated the association between socioeconomic status (SES) with CVD and cardiovascular risk factors (CVRFs). It is necessary to elucidate the association of SES and CVRFs with CVD. Subject and methods We searched PubMed, Embase, Web of Science, and the Cochrane Library for publications, using "socioeconomic status," "cardiovascular disease," and corresponding synonyms to obtain literature. The quality of studies was evaluated using the National Institutes of Health Quality Assessment Tool (NIH-QAT). All analyses were performed using Stata V.12.0. Results There were 31 eligible studies included in this meta-analysis. All studies presented a low risk of bias via NIH-QAT assessment. As for CVD incidence/mortality, pooled hazard ratios (HR) of low and middle vs. high income were [HR = 1.22 (1.17-1.28); HR = 1.12 (1.09-1.16)] and [HR = 1.37 (1.21-1.56); HR = 1.19 (1.06-1.34)]. The HR of education were [HR = 1.44 (1.28-1.63); HR = 1.2 (1.11-1.3)] and [HR = 1.5 (1.22-1.83); HR = 1.13 (1.05-1.22)]. The HR of deprivation were [HR = 1.28 (1.16-1.41); HR = 1.07 (1.03-1.11)] and [HR = 1.19 (1.11-1.29); HR = 1.1 (1.02-1.17)]. SES was negatively correlated with CVD outcomes. A subgroup analysis of gender and national income level also yielded a negative correlation, and additional details were also obtained. Conclusions SES is inversely correlated with CVD outcomes and the prevalence of CVRFs. As for CVD incidence, women may be more sensitive to income and education. In terms of CVD mortality, men may be more sensitive to income and education, and people from low- and middle-income countries are sensitive to income and education. Supplementary Information The online version contains supplementary material available at 10.1007/s10389-023-01825-4.
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Affiliation(s)
- Tao Wang
- School of Economics and Management, Southwest Petroleum University, NO. 8 Xindu Avenue, Xindu District, Chengdu City, Sichuan Province China
| | - Yilin Li
- Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Xiaoqiang Zheng
- School of Economics and Management, Southwest Petroleum University, NO. 8 Xindu Avenue, Xindu District, Chengdu City, Sichuan Province China
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Socioeconomic inequity in incidence, outcomes and care for acute coronary syndrome: A systematic review. Int J Cardiol 2022; 356:19-29. [DOI: 10.1016/j.ijcard.2022.03.053] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 02/17/2022] [Accepted: 03/24/2022] [Indexed: 12/17/2022]
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Tizón-Marcos H, Vaquerizo B, Ferré JM, Farré N, Lidón RM, Garcia-Picart J, Regueiro A, Ariza A, Carrillo X, Duran X, Poirier P, Cladellas M, Camps-Vilaró A, Ribas N, Cubero-Gallego H, Marrugat J. Socioeconomic Status and Prognosis of Patients With ST-Elevation Myocardial Infarction Managed by the Emergency-Intervention “Codi IAM” Network. Front Cardiovasc Med 2022; 9:847982. [PMID: 35548422 PMCID: PMC9082814 DOI: 10.3389/fcvm.2022.847982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 03/18/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundDespite the spread of ST-elevation myocardial infarction (STEMI) emergency intervention networks, inequalities in healthcare access still have a negative impact on cardiovascular prognosis. The Family Income Ratio of Barcelona (FIRB) is a socioeconomic status (SES) indicator that is annually calculated. Our aim was to evaluate whether SES had an effect on mortality and complications in patients managed by the “Codi IAM” network in Barcelona.MethodsThis is a cohort study with 3,322 consecutive patients with STEMI treated in Barcelona from 2010 to 2016. Collected data include treatment delays, clinical and risk factor characteristics, and SES. The patients were assigned to three SES groups according to FIRB score. A logistic regression analysis was conducted to estimate the adjusted effect of SES on 30-day mortality, 30-day composite cardiovascular end point, and 1-year mortality.ResultsThe mean age of the patients was 65 ± 13% years, 25% were women, and 21% had diabetes mellitus. Patients with low SES were younger, more often hypertensive, diabetic, dyslipidemic (p < 0.003), had longer reperfusion delays (p < 0.03) compared to participants with higher SES. Low SES was not independently associated with 30-day mortality (OR: 0.95;9 5% CI: 0.7–1.3), 30-day cardiovascular composite end point (OR: 1.03; 95% CI: 0.84–1.26), or 1-year all-cause mortality (HR: 1.09; 95% CI: 0.76–1.56).ConclusionAlthough the low-SES patients with STEMI in Barcelona city were younger, had worse clinical profiles, and had longer revascularization delays, their 30-day and 1-year outcomes were comparable to those of the higher-SES patients.
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Affiliation(s)
- Helena Tizón-Marcos
- Hospital del Mar, Servicio de Cardiología, Barcelona, Spain
- Grupo de Investigación Biomédica en Enfermedades del Corazón, Barcelona, Spain
- IMIM (Instituto Hospital del Mar de Investigaciones Médicas), Barcelona, Spain
- Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares, Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- *Correspondence: Helena Tizón-Marcos
| | - Beatriz Vaquerizo
- Hospital del Mar, Servicio de Cardiología, Barcelona, Spain
- Grupo de Investigación Biomédica en Enfermedades del Corazón, Barcelona, Spain
- IMIM (Instituto Hospital del Mar de Investigaciones Médicas), Barcelona, Spain
- Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares, Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Facultat de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Josepa Mauri Ferré
- Hospital Universitari GermansTrias I. Pujol, Servicio de Cardiología, Badalona, Spain
- Departament de Salut, Generalitat de Catalunya, Barcelona, Spain
| | - Núria Farré
- Hospital del Mar, Servicio de Cardiología, Barcelona, Spain
- Grupo de Investigación Biomédica en Enfermedades del Corazón, Barcelona, Spain
- IMIM (Instituto Hospital del Mar de Investigaciones Médicas), Barcelona, Spain
- Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares, Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Facultat de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Rosa-Maria Lidón
- Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares, Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Hospital Universitari de la Valld'Hebron, Servicio de Cardiología, Barcelona, Spain
| | - Joan Garcia-Picart
- Hospital de la Santa Creu I. Sant Pau, Servicio de Cardiología, Barcelona, Spain
| | - Ander Regueiro
- Hospital Clínic i Provincial, Servicio de Cardiología, Barcelona, Spain
| | - Albert Ariza
- Hospital Universitario de Bellvitge, Servicio de Cardiología, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Xavier Carrillo
- Hospital Universitari GermansTrias I. Pujol, Servicio de Cardiología, Badalona, Spain
| | - Xavier Duran
- IMIM (Instituto Hospital del Mar de Investigaciones Médicas), Barcelona, Spain
- AMIB, Assessoria Metodològica i Bioestadística, Barcelona, Spain
| | - Paul Poirier
- Insititut Universitaire de Cardiologie et Pneumologie de Québec, Québec, QC, Canada
| | - Mercè Cladellas
- Hospital del Mar, Servicio de Cardiología, Barcelona, Spain
- Grupo de Investigación Biomédica en Enfermedades del Corazón, Barcelona, Spain
- IMIM (Instituto Hospital del Mar de Investigaciones Médicas), Barcelona, Spain
- Facultat de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Anna Camps-Vilaró
- IMIM (Instituto Hospital del Mar de Investigaciones Médicas), Barcelona, Spain
- Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares, Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Núria Ribas
- Hospital del Mar, Servicio de Cardiología, Barcelona, Spain
- Grupo de Investigación Biomédica en Enfermedades del Corazón, Barcelona, Spain
- IMIM (Instituto Hospital del Mar de Investigaciones Médicas), Barcelona, Spain
- Facultat de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Hector Cubero-Gallego
- Hospital del Mar, Servicio de Cardiología, Barcelona, Spain
- Grupo de Investigación Biomédica en Enfermedades del Corazón, Barcelona, Spain
- IMIM (Instituto Hospital del Mar de Investigaciones Médicas), Barcelona, Spain
| | - Jaume Marrugat
- IMIM (Instituto Hospital del Mar de Investigaciones Médicas), Barcelona, Spain
- Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares, Instituto de Salud Carlos III (ISCIII), Madrid, Spain
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Mozaffarian S, Etemad K, Aghaali M, Khodakarim S, Sotoodeh Ghorbani S, Hashemi Nazari SS. Short and Long-Term Survival Rates Following Myocardial Infarction and Its Predictive Factors: A Study Using National Registry Data. J Tehran Heart Cent 2022; 16:68-74. [PMID: 35082874 PMCID: PMC8742861 DOI: 10.18502/jthc.v16i2.7387] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 03/09/2021] [Indexed: 12/02/2022] Open
Abstract
Background: Coronary artery disease is the most common cause of death worldwide as well as in Iran. The present study was designed to predict short and long-term survival rates after the first episode of myocardial infarction (MI). Methods: The current research is a retrospective cohort study. The data were collected from the Myocardial Infarction Registry of Iran in a 12-month period leading to March 20, 2014. The variables analyzed included smoking status, past medical history of chronic heart disease, hypertension, diabetes, hyperlipidemia, signs and symptoms during an attack, post-MI complications during hospitalization, the occurrence of arrhythmias, the location of MI, and the place of residence. Survival rates and predictive factors were estimated by the Kaplan–Meier method, the log-rank test, and the Cox model. Results: Totally, 21 181 patients with the first MI were studied. There were 15 328 men (72.4%), and the mean age of the study population was 62.10±13.42 years. During a 1-year period following MI, 2479 patients (11.7%) died. Overall, the survival rates at 28 days, 6 months, and 1 year were estimated to be 0.95 (95% CI: 0.95 to 0.96), 0.90 (95% CI: 0.90 to 0.91), and 0.88 (95% CI: 0.88 to 0.89). After the confounding factors were controlled, history of chronic heart disease (p<0.001), hypertension (p<0.001), and diabetes (p<0.001) had a significant relationship with an increased risk of death and history of hyperlipidemia (p<0.001) and inferior wall MI (p<0.001) had a significant relationship with a decreased risk of death. Conclusion: The results of this study provide evidence for health policy-makers and physicians on the link between MI and its predictive factors.
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Affiliation(s)
- Samaneh Mozaffarian
- School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Korosh Etemad
- Environmental and Occupational Hazard Control Research Center, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Aghaali
- School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Soheila Khodakarim
- School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sahar Sotoodeh Ghorbani
- School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Seyed Saeed Hashemi Nazari
- Prevention of Cardiovascular Disease Research Center, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Moledina A, Tang KL. Socioeconomic Status, Mortality, and Access to Cardiac Services After Acute Myocardial Infarction in Canada: A Systematic Review and Meta-analysis. CJC Open 2021; 3:950-964. [PMID: 34401702 PMCID: PMC8347872 DOI: 10.1016/j.cjco.2021.02.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 02/01/2021] [Indexed: 12/13/2022] Open
Abstract
Background Low socioeconomic status (SES) is an important prognosticator for those with acute myocardial infarction (AMI), having previously been described to be associated with increased short-term mortality. Whether this effect persists over time, and whether access to cardiac interventions is equitable within Canada’s universal health care system, remains unknown. Methods We conducted a systematic review to determine the associations of SES with mortality and access to a spectrum of interventions including cardiac catheterization, revascularization, and cardiac rehabilitation. Electronic databases (EMBASE and MEDLINE) were searched in March 2019 and December 2019. Original studies from Canada examining associations between SES and any of the above outcomes in AMI patients were included. Meta-analyses were conducted using random effects models. Results Nineteen studies were included, 11 of which could be meta-analyzed. Low SES was associated with a 48% and 34% increase in short-term and intermediate-term mortality, respectively. There was a trend toward increased long-term mortality more than 1-year post-event (pooled odds ratio [OR] 1.34 [95% confidence interval {CI} 0.95-1.88]). Low SES was also associated with lower rates of cardiac catheterization (pooled OR 0.80 [95% CI 0.65-0.99]) and revascularization (pooled OR 0.76 [95% CI 0.63-0.90]) post-AMI. Studies on cardiac rehabilitation showed reduced access and participation in low-SES groups. Conclusions Low SES is associated with not only increased mortality post-AMI, but also reduced access to cardiac interventions that have demonstrated benefits for mortality and morbidity. Interventions that improve access to catheterization, revascularization, and cardiac rehabilitation for low-SES populations are needed if true equitable care in Canada is desired.
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Affiliation(s)
- Aliza Moledina
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Karen L Tang
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada.,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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Effects of socioeconomic status on mortality after Parkinson's disease: A nationwide population-based matched cohort study in Korean populations. Parkinsonism Relat Disord 2020; 80:206-211. [PMID: 33129703 DOI: 10.1016/j.parkreldis.2020.10.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 08/29/2020] [Accepted: 10/09/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION To evaluate the mortality rate and impact of SES on mortality in PD using a nationwide cohort in Korea. METHODS We selected patients diagnosed with PD (ICD-10 code: G20) and registration code for PD (V124) in the program for rare intractable diseases between 2004 and 2015. After that, atypical parkinsonism was excluded. A matched cohort of individuals without PD were enrolled by randomly matching patients by sex, age, and year of diagnosis to the PD group with a ratio of 1:9. Cox proportional hazard models were used to identify the effects of SES on mortality using Hazard Ratios and 95% confidence intervals. RESULTS In total, 26,570 participants were enrolled. The mortality rate was 30.37% in PD cohort and 16.69% in the comparison cohort. According to income level, PD patients in low-middle group revealed significantly decreased HRs of 0.704 (95% CI, 0.533-0.930) compared to those in the lowest group. The medical aid group showed an increased mortality rate (HR = 1.552, 95% CI, 1.191-2.021) compared to the national health insurance group. In the subgroup analyses, medical aid was associated with mortality only in PD with female (HR = 1.740, 95% CI, 1.242-2.438) or aged 60-79 years (HR = 1.434, 95% CI 1.005-2.045). There was no significant difference in mortality rate according to residential area in PD. CONCLUSIONS In Korea, individual level low SES including income level and insurance type were significantly associated with increased mortality, whereas regional level SES (residential area) was not related with mortality on PD.
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Steele L, Palmer J, Lloyd A, Fotheringham J, Iqbal J, Grech ED. Impact of socioeconomic status on survival following ST-elevation myocardial infarction in a universal healthcare system. Int J Cardiol 2019; 276:26-30. [DOI: 10.1016/j.ijcard.2018.11.111] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 10/02/2018] [Accepted: 11/21/2018] [Indexed: 10/27/2022]
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Abstract
The article presents a literature review of the modern conception of postinfarction rupture of the myocardium and predictors of its development.
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The impact of socioeconomic status on the association between biomedical and psychosocial well-being and all-cause mortality in older Spanish adults. Soc Psychiatry Psychiatr Epidemiol 2018; 53:259-268. [PMID: 29322199 DOI: 10.1007/s00127-018-1480-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Accepted: 01/02/2018] [Indexed: 12/21/2022]
Abstract
PURPOSE The aim of this paper was to analyze the effect of biomedical and psychosocial well-being, based on distinct successful aging models (SA), on time to mortality, and determine whether this effect was modified by socioeconomic status (SES) in a nationally representative sample of older Spanish adults. METHODS Data were taken from a 3-year follow-up study with 2783 participants aged 50 or over. Vital status was ascertained using national registers or asking participants' relatives. Kaplan-Meier curves were used to estimate the time to death by SES, and levels of biomedical and psychosocial SA. Cox proportional hazard regression models were conducted to explore interactions between SES and SA models while adjusting for gender, age, and marital status. RESULTS Lower levels of SES and biomedical and psychosocial SA were associated with low probability of survival. Only the interaction between SES and biomedical SA was significant. Biomedical SA impacted on mortality rates among individuals with low SES but not on those with medium or high SES, whereas psychosocial SA affected mortality regardless of SES. CONCLUSIONS Promoting equal access to health care system and improved psychosocial well-being could be a protective factor against premature mortality in older Spanish adults with low SES.
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van de Vorst IE, Koek HL, Stein CE, Bots ML, Vaartjes I. Socioeconomic Disparities and Mortality After a Diagnosis of Dementia: Results From a Nationwide Registry Linkage Study. Am J Epidemiol 2016; 184:219-26. [PMID: 27380760 DOI: 10.1093/aje/kwv319] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Accepted: 11/06/2015] [Indexed: 11/13/2022] Open
Abstract
Low socioeconomic status (SES) has been linked to a higher incidence of dementia. Less is known about the association between SES and mortality in persons with dementia. We studied this association in a prospective cohort of 15,558 patients in the Netherlands between 2000 and 2010. SES was measured using disposable household income and divided in tertiles. Overall, there was a negative relationship between SES and mortality in both sexes and both settings of care. For men who visited a day clinic, the 5-year mortality rate was 74% among those in the lowest tertile of SES and 57% among those in the highest; for women, the rates were 60% and 50%, respectively. The differences in median survival times between persons in the lower and upper tertiles of SES were 260 days for men and 300 days for women. For men who were admitted to the hospital, the 5-year mortality rate was 89% among those in the lowest tertile of SES and 86% among those in the highest; for women, the rates were 83% and 77%, respectively. The differences in median survival times between persons in the lower and upper tertiles of SES were 80 days for men and 130 days for women. Among patients who visited a day clinic, for patients in the lowest tertile of SES versus those in the highest, the adjusted hazard ratio was 1.41 (95% confidence interval: 1.26, 1.57); for those admitted to the hospital, it was 1.14 (95% confidence interval: 1.07, 1.20). In summary, lower SES was associated with a higher mortality risk in both men and women with dementia. The results of the present study should raise awareness in clinicians and caregivers about the unfavorable prognosis in the most deprived patients.
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Lewis MW, Khodneva Y, Redmond N, Durant RW, Judd SE, Wilkinson LL, Howard VJ, Safford MM. The impact of the combination of income and education on the incidence of coronary heart disease in the prospective Reasons for Geographic and Racial Differences in Stroke (REGARDS) cohort study. BMC Public Health 2015; 15:1312. [PMID: 26715537 PMCID: PMC4696109 DOI: 10.1186/s12889-015-2630-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Accepted: 12/16/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND We investigated the association between income-education groups and incident coronary heart disease (CHD) in a national prospective cohort study. METHODS The REasons for Geographic And Racial Differences in Stroke study recruited 30,239 black and white community-dwelling adults between 2003 and 2007 and collected participant-reported and in-home physiologic variables at baseline, with expert adjudicated CHD endpoints during follow-up. Mutually exclusive income-education groups were: low income (annual household income <$35,000)/low education (< high school), low income/high education, high income/low education, and high income/high education. Cox models estimated hazard ratios (HR) for incident CHD for each exposure group, examining differences by age group. RESULTS At baseline, 24,461 participants free of CHD experienced 809 incident CHD events through December 31, 2011 (median follow-up 6.0 years; interquartile range 4.5-7.3 years). Those with low income/low education had the highest incidence of CHD (10.1 [95% CI 8.4-12.1]/1000 person-years). After full adjustment, those with low income/low education had higher risk of incident CHD (HR 1.42 [95% CI: 1.14-1.76]) than those with high income/high education, but findings varied by age. Among those aged <65 years, compared with those reporting high income/high education, risk of incident CHD was significantly higher for those reporting low income/low education and low income/high education (adjusted HR 2.07 [95% CI 1.42-3.01] and 1.69 [95% CI 1.30-2.20], respectively). Those aged ≥ 65 years, risk of incident CHD was similar across income-education groups after full adjustment. CONCLUSION For younger individuals, low income, regardless of education, was associated with higher risk of CHD, but not observed for ≥ 65 years. Findings suggest that for younger participants, education attainment may not overcome the disadvantage conferred by low income in terms of CHD risk, whereas among those ≥ 65 years, the independent effects of income and education are less pronounced.
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Affiliation(s)
- Marquita W Lewis
- Department of Human Studies, School of Education, College of Arts and Sciences, University of Alabama at Birmingham, 901 13th Street South, Birmingham, AL, 35294-1250, USA. .,Department of Medicine, School of Medicine, University of Alabama at Birmingham, 1720 2nd Ave South, Birmingham, AL, 35294-4410, USA.
| | - Yulia Khodneva
- Department of Medicine, School of Medicine, University of Alabama at Birmingham, 1720 2nd Ave South, Birmingham, AL, 35294-4410, USA.
| | - Nicole Redmond
- Department of Medicine, School of Medicine, University of Alabama at Birmingham, 1720 2nd Ave South, Birmingham, AL, 35294-4410, USA.
| | - Raegan W Durant
- Department of Medicine, School of Medicine, University of Alabama at Birmingham, 1720 2nd Ave South, Birmingham, AL, 35294-4410, USA.
| | - Suzanne E Judd
- Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, 1665 University Boulevard, Birmingham, AL, 35294-0022, USA.
| | - Larrell L Wilkinson
- Department of Human Studies, School of Education, College of Arts and Sciences, University of Alabama at Birmingham, 901 13th Street South, Birmingham, AL, 35294-1250, USA.
| | - Virginia J Howard
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, 1665 University Boulevard, Birmingham, AL, 35294-0022, USA.
| | - Monika M Safford
- Department of Medicine, School of Medicine, University of Alabama at Birmingham, 1720 2nd Ave South, Birmingham, AL, 35294-4410, USA.
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Kilpi F, Silventoinen K, Konttinen H, Martikainen P. Disentangling the relative importance of different socioeconomic resources for myocardial infarction incidence and survival: a longitudinal study of over 300,000 Finnish adults. Eur J Public Health 2015; 26:260-6. [PMID: 26585783 DOI: 10.1093/eurpub/ckv202] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Lower socioeconomic position (SEP) is associated with an increased risk of myocardial infarction (MI) incidence and mortality, but the relative importance of different socioeconomic resources at different stages of the disease remains unclear. METHODS A nationally representative register-based sample of 40- to 60-year-old Finnish men and women in 1995 (n= 302 885) were followed up for MI incidence and mortality in 1996-2007. We compared the effects of education, occupation, income and wealth on first MI incidence, first-day and long-term fatality. Cox's proportional hazards regression and logistic regression models were estimated adjusting for SEP covariates simultaneously to assess independent effects. RESULTS Fully adjusted models showed greatest relative inequalities of MI incidence by wealth in both sexes, with an increased risk also associated with manual occupations. Education was a significant predictor of incidence in men. Low income was associated with a greater risk of death on the day of MI incidence [odds ratio (OR) = 1.40 in men and 1.95 in women when comparing lowest and highest income quintiles], and in men, with long-term fatality [hazard ratio (HR) = 1.74]. Wealth contributed to inequalities in first-day fatality in men and in long-term fatality in both sexes. CONCLUSION The results show that different socioeconomic resources have diverse effects on the disease process and add new evidence on the significant association of wealth with heart disease onset and fatality. Targeting those with the least resources could improve survival in MI patients and help reduce social inequalities in coronary heart disease mortality.
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Affiliation(s)
- Fanny Kilpi
- 1 Population Research Unit, Department of Social Research, University of Helsinki, Helsinki, Finland
| | - Karri Silventoinen
- 1 Population Research Unit, Department of Social Research, University of Helsinki, Helsinki, Finland
| | - Hanna Konttinen
- 2 Social Psychology, Department of Social Research, University of Helsinki, Helsinki, Finland
| | - Pekka Martikainen
- 1 Population Research Unit, Department of Social Research, University of Helsinki, Helsinki, Finland 3 Centre for Health Equity Studies (CHESS), Stockholms Universitet and Karolinska Institutet, Sweden 4 The Max Planck Institute for Demographic Research, Germany
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Osler M, Prescott E, Wium-Andersen IK, Ibfelt EH, Jørgensen MB, Andersen PK, Jørgensen TSH, Wium-Andersen MK, Mårtensson S. The Impact of Comorbid Depression on Educational Inequality in Survival after Acute Coronary Syndrome in a Cohort of 83 062 Patients and a Matched Reference Population. PLoS One 2015; 10:e0141598. [PMID: 26513652 PMCID: PMC4626047 DOI: 10.1371/journal.pone.0141598] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Accepted: 10/09/2015] [Indexed: 11/28/2022] Open
Abstract
Background Patients with low socioeconomic position have higher rates of mortality after diagnosis of acute coronary syndrome (ACS), but little is known about the mechanisms behind this social inequality. The aim of the present study was to examine whether any educational inequality in survival after ACS was influenced by comorbid conditions including depression. Methods From 2001 to 2009 all first-time ACS patients were identified in the Danish National Patient Registry. This cohort of 83 062 ACS patients and a matched reference population were followed for incident depression and mortality until December 2012 by linkage to person, patients and prescription registries. Educational status was defined at study entry and the impact of potential confounders and mediators (age, gender, cohabitation status, somatic comorbidity and depression) on the relation between education and mortality were identified by drawing a directed acyclic graph and analysed using multiple Cox regression analyses. Findings During follow-up, 29 583(35.6%) of ACS patients and 19 105(22.9%) of the reference population died. Cox regression analyses showed an increased mortality in the lowest educated compared to those with high education in both ACS patients and the reference population. Adjustment for previous and incident depression or other covariables only attenuated the relations slightly. This pattern of associations was seen for mortality after 30 days, 1 year and during total follow-up. Conclusion In this study the relative excess mortality rate in lower educated ACS patients was comparable with the excess risk associated with low education in the background population. This educational inequality in survival remained after adjustment for somatic comorbidity and depression.
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Affiliation(s)
- Merete Osler
- Research Center for Prevention and Health, Rigshospitalet – Glostrup, Copenhagen University, Glostrup, Denmark
- * E-mail:
| | - Eva Prescott
- Department of Cardiology Y, Bispebjerg Hospital, Copenhagen, Denmark
| | | | - Else Helene Ibfelt
- Research Center for Prevention and Health, Rigshospitalet – Glostrup, Copenhagen University, Glostrup, Denmark
| | | | - Per Kragh Andersen
- Department of Biostatistics, University of Copenhagen, Copenhagen, Denmark
| | - Terese Sara Høj Jørgensen
- Research Center for Prevention and Health, Rigshospitalet – Glostrup, Copenhagen University, Glostrup, Denmark
| | | | - Solvej Mårtensson
- Research Center for Prevention and Health, Rigshospitalet – Glostrup, Copenhagen University, Glostrup, Denmark
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Pande RL, Creager MA. Socioeconomic inequality and peripheral artery disease prevalence in US adults. CIRCULATION-CARDIOVASCULAR QUALITY AND OUTCOMES 2015; 7:532-9. [PMID: 24987053 DOI: 10.1161/circoutcomes.113.000618] [Citation(s) in RCA: 92] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Lower socioeconomic status is associated with cardiovascular disease. We sought to determine whether there is a higher prevalence of peripheral artery disease (PAD) in individuals with lower socioeconomic status. METHODS AND RESULTS We analyzed data from the National Health and Nutrition Examination Survey 1999 to 2004. PAD was defined based on an ankle.brachial index .0.90. Measures of socioeconomic status included poverty.income ratio,a ratio of self-reported income relative to the poverty line, and attained education level. Of 6791 eligible participants,overall weighted prevalence of PAD was 5.8% (SE, 0.3). PAD prevalence was significantly higher in individuals with low income and lower education. Individuals in the lowest of the 6 poverty.income ratio categories had more than a2-fold increased odds of PAD compared with those in the highest poverty-income ratio category (odds ratio, 2.69; 95%confidence interval, 1.80.4.03; P<0.0001). This association remained significant even after multivariable adjustment(odds ratio, 1.64; 95% confidence interval, 1.04.2.6; P=0.034). Lower attained education level also associated with higher PAD prevalence (odds ratio, 2.8; 95% confidence interval, 1.96.4.0; P<0.0001) but was no longer significant after multivariable adjustment. CONCLUSIONS Low income and lower attained education level are associated with PAD in US adults. These data suggest that individuals of lower socioeconomic status remain at high risk and highlight the need for education and advocacy efforts focused on these at-risk populations.
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Manderbacka K, Arffman M, Lumme S, Keskimäki I. Are there socioeconomic differences in outcomes of coronary revascularizations--a register-based cohort study. Eur J Public Health 2015; 25:984-9. [PMID: 25958240 DOI: 10.1093/eurpub/ckv086] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Earlier studies have reported socioeconomic differences in coronary heart disease incidence and mortality and in coronary treatment, but less is known about outcomes of care. We examined trends in income group differences in outcomes of coronary revascularizations among Finnish residents in 1998-2010. METHODS First revascularizations for 45-84-year-old Finns were extracted from the Hospital Discharge Register in 1998-2009 and followed until 31 December 2010. Income was individually linked to them and adjusted for family size. We examined the risk of major adverse cardiac events (MACEs), coronary mortality and re-revascularization. We calculated age-standardized rates with direct method and Cox regression models. RESULTS Altogether 69 076 men and 27 498 women underwent revascularization during the study period. Among men [women] in the 1998 cohort, 41% [35%] suffered MACE during 29 days after the operation and 30% [28%] in the 2009 cohort. Myocardial infarction mortality within 1 year was 2% among both genders in both cohorts. Among men [women] 9% [14%] underwent revascularization within 1 year after the operation in 1998 and 12% [12%] in 2009. Controlling for age, co-morbidities, year, previous infarction and disease severity, an inverse income gradient was found in MACE incidence within 29 days and in coronary mortality. The excess MACE risk was 1.39 and excess mortality risk over 1.70 among both genders in the lowest income quintile. All income group differences remained stable from 1998 to 2010. CONCLUSIONS In health care, more attention should be paid to prevention of adverse outcomes among persons with low socioeconomic position undergoing revascularization.
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Affiliation(s)
- Kristiina Manderbacka
- 1 Health and Social Systems Research Unit, Department of Health and Social Care Systems, National Institute for Health and Welfare, P. O. Box 30, 00271 Helsinki, Finland
| | - Martti Arffman
- 1 Health and Social Systems Research Unit, Department of Health and Social Care Systems, National Institute for Health and Welfare, P. O. Box 30, 00271 Helsinki, Finland
| | - Sonja Lumme
- 1 Health and Social Systems Research Unit, Department of Health and Social Care Systems, National Institute for Health and Welfare, P. O. Box 30, 00271 Helsinki, Finland
| | - Ilmo Keskimäki
- 1 Health and Social Systems Research Unit, Department of Health and Social Care Systems, National Institute for Health and Welfare, P. O. Box 30, 00271 Helsinki, Finland School of Health Sciences, University of Tampere, 33014 Tampere, Finland
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Early origins of chronic obstructive lung diseases across the life course. Eur J Epidemiol 2014; 29:871-85. [PMID: 25537319 DOI: 10.1007/s10654-014-9981-5] [Citation(s) in RCA: 83] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Accepted: 12/06/2014] [Indexed: 12/12/2022]
Abstract
Chronic obstructive lung diseases, like asthma and chronic obstructive pulmonary disease, have high prevalences and are a major public health concern. Chronic obstructive lung diseases have at least part of their origins in early life. Exposure to an adverse environment during critical periods in early life might lead to permanent developmental adaptations which results in impaired lung growth with smaller airways and lower lung volume, altered immunological responses and related inflammation, and subsequently to increased risks of chronic obstructive lung diseases throughout the life course. Various pathways leading from early life factors to respiratory health outcomes in later life have been studied, including fetal and early infant growth patterns, preterm birth, maternal obesity, diet and smoking, children's diet, allergen exposure and respiratory tract infections, and genetic susceptibility. Data on potential adverse factors in the embryonic and preconception period and respiratory health outcomes are scarce. Also, the underlying mechanisms how specific adverse exposures in the fetal and early postnatal period lead to chronic obstructive lung diseases in later life are not yet fully understood. Current studies suggest that interactions between early environmental exposures and genetic factors such as changes in DNA-methylation and RNA expression patterns may explain the early development of chronic obstructive lung diseases. New well-designed epidemiological studies are needed to identify specific critical periods and to elucidate the mechanisms underlying the development of chronic obstructive lung disease throughout the life course.
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The Generation R Study: Biobank update 2015. Eur J Epidemiol 2014; 29:911-27. [PMID: 25527369 DOI: 10.1007/s10654-014-9980-6] [Citation(s) in RCA: 174] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2014] [Accepted: 12/06/2014] [Indexed: 12/14/2022]
Abstract
The Generation R Study is a population-based prospective cohort study from fetal life until adulthood. The study is designed to identify early environmental and genetic causes and causal pathways leading to normal and abnormal growth, development and health from fetal life, childhood and young adulthood. In total, 9,778 mothers were enrolled in the study. Data collection in children and their parents include questionnaires, interviews, detailed physical and ultrasound examinations, behavioural observations, Magnetic Resonance Imaging and biological samples. Efforts have been conducted for collecting biological samples including blood, hair, faeces, nasal swabs, saliva and urine samples and generating genomics data on DNA, RNA and microbiome. In this paper, we give an update of the collection, processing and storage of these biological samples and available measures. Together with detailed phenotype measurements, these biological samples provide a unique resource for epidemiological studies focused on environmental exposures, genetic and genomic determinants and their interactions in relation to growth, health and development from fetal life onwards.
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Educational inequalities in 28 day and 1-year mortality after hospitalisation for incident acute myocardial infarction--a nationwide cohort study. Int J Cardiol 2014; 177:874-80. [PMID: 25453405 DOI: 10.1016/j.ijcard.2014.10.045] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2014] [Revised: 10/09/2014] [Accepted: 10/18/2014] [Indexed: 11/24/2022]
Abstract
BACKGROUND There is little recent evidence on the impact of comorbidities and access to revascularisation procedures on educational inequalities in mortality after acute myocardial infarction (AMI). The aim of the study was to investigate educational inequalities in mortality among all patients hospitalised for an incident AMI during 2001-2009 in Norway. METHODS Data were obtained through the Cardiovascular Disease in Norway (CVDNOR) project. Incident AMI was defined as an AMI-hospitalisation without any AMI-events in the previous 7 years. Education was categorised as basic, upper secondary or tertiary (college/university). Cox regression was used to assess educational differences in 28-day and 29-365-day mortality after an incident AMI in terms of hazard ratios and relative index of inequality (RII). RII can be interpreted as the ratio in mortality between the 0 th and the 100th percentile of the education distribution. RESULTS 111 993 incident AMIs were included (39.4% women). Among patients aged 35-69, RIIs (95% CI) adjusted for age, sex and year were 1.86 (1.59-2.18) and 2.10 (1.69-2.59) for 28-day and 29-365-day mortality respectively. Among patients aged 70-94 the corresponding RIIs were 1.12 (1.06-1.30) and 1.28 (1.19-1.38). Educational inequalities in mortality were attenuated after adjustment for comorbidities and revascularisation, but were still significant. Educational inequalities did not decrease during 2001-2009. CONCLUSION Educational inequalities in both 28-day and 29-365 day mortality were strong and persistent during 2001-2009. Further research is needed to investigate if these disparities are driven by inequalities in the severity of the AMI or by inequitable access to treatment and rehabilitation.
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Agyemang C, van Oeffelen AA, Norredam M, Kappelle LJ, Klijn CJ, Bots ML, Stronks K, Vaartjes I. Socioeconomic Inequalities in Stroke Incidence Among Migrant Groups. Stroke 2014; 45:2397-403. [DOI: 10.1161/strokeaha.114.005505] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Charles Agyemang
- From the Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands (C.A., K.S.); Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands (A.A.v.O., M.L.B., I.V.); Section of Health Services Research, Department of Public Health, Danish Research Centre for Migration, Ethnicity, and Health, University of Copenhagen, Copenhagen, Denmark (M.N.); Section of Infectious Diseases, Department of Immigrant
| | - Aloysia A. van Oeffelen
- From the Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands (C.A., K.S.); Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands (A.A.v.O., M.L.B., I.V.); Section of Health Services Research, Department of Public Health, Danish Research Centre for Migration, Ethnicity, and Health, University of Copenhagen, Copenhagen, Denmark (M.N.); Section of Infectious Diseases, Department of Immigrant
| | - Marie Norredam
- From the Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands (C.A., K.S.); Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands (A.A.v.O., M.L.B., I.V.); Section of Health Services Research, Department of Public Health, Danish Research Centre for Migration, Ethnicity, and Health, University of Copenhagen, Copenhagen, Denmark (M.N.); Section of Infectious Diseases, Department of Immigrant
| | - L. Jaap Kappelle
- From the Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands (C.A., K.S.); Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands (A.A.v.O., M.L.B., I.V.); Section of Health Services Research, Department of Public Health, Danish Research Centre for Migration, Ethnicity, and Health, University of Copenhagen, Copenhagen, Denmark (M.N.); Section of Infectious Diseases, Department of Immigrant
| | - Catharina J.M. Klijn
- From the Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands (C.A., K.S.); Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands (A.A.v.O., M.L.B., I.V.); Section of Health Services Research, Department of Public Health, Danish Research Centre for Migration, Ethnicity, and Health, University of Copenhagen, Copenhagen, Denmark (M.N.); Section of Infectious Diseases, Department of Immigrant
| | - Michiel L. Bots
- From the Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands (C.A., K.S.); Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands (A.A.v.O., M.L.B., I.V.); Section of Health Services Research, Department of Public Health, Danish Research Centre for Migration, Ethnicity, and Health, University of Copenhagen, Copenhagen, Denmark (M.N.); Section of Infectious Diseases, Department of Immigrant
| | - Karien Stronks
- From the Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands (C.A., K.S.); Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands (A.A.v.O., M.L.B., I.V.); Section of Health Services Research, Department of Public Health, Danish Research Centre for Migration, Ethnicity, and Health, University of Copenhagen, Copenhagen, Denmark (M.N.); Section of Infectious Diseases, Department of Immigrant
| | - Ilonca Vaartjes
- From the Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands (C.A., K.S.); Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands (A.A.v.O., M.L.B., I.V.); Section of Health Services Research, Department of Public Health, Danish Research Centre for Migration, Ethnicity, and Health, University of Copenhagen, Copenhagen, Denmark (M.N.); Section of Infectious Diseases, Department of Immigrant
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Li Y, Rukshin I, Pan F, Sen S, Islam M, Yousif A, Rukshin V. The impact of the 2008-2009 economic recession on acute myocardial infarction occurrences in various socioeconomic areas of raritan bay region, new jersey. NORTH AMERICAN JOURNAL OF MEDICAL SCIENCES 2014; 6:215-8. [PMID: 24926446 PMCID: PMC4049054 DOI: 10.4103/1947-2714.132938] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Psychosocial stress is one important risk factor for myocardial infarction. Aim: The study was to assess the impact of the 2008-2009 economic recession on myocardial infarction occurrences in different socioeconomic areas of Raritan Bay region, New Jersey. Materials and Methods: The patients, who were treated for acute myocardial infarction from January 2006 to June 2012, were grouped based on the average incomes of their residence districts in the Raritan Bay region. The Spearman Rank Correlation test was used to assess the correlation between the monthly occurrences of myocardial infarction and Dow Jones stock averages, as well as the correlation between the myocardial infarction occurrences and NJ State unemployment rates. Results: Among 1,491 cases that were identified, 990 cases resided in areas with income below the state average and 477 were from areas above the average. After the onset of the recession, the myocardial infarction occurrences trended up in the low-income area group but not in the high-income area group; and this increasing trend is correlated with the rise in NJ State unemployment rates but not with the changes in stock averages. Conclusion: Our findings suggest that unemployment contributed to an increased risk of myocardial infarction among the residents in low socioeconomic areas after the 2008-2009 economic recession.
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Affiliation(s)
- Yulong Li
- Department of Medicine, Raritan Bay Medical Center, Perth Amboy, New Jersey, USA
| | - Iris Rukshin
- Department of Medicine, Raritan Bay Medical Center, Perth Amboy, New Jersey, USA
| | - Fangfang Pan
- Department of Medicine, Raritan Bay Medical Center, Perth Amboy, New Jersey, USA
| | - Shuvendu Sen
- Department of Medicine, Raritan Bay Medical Center, Perth Amboy, New Jersey, USA
| | - Mohammed Islam
- Department of Medicine, Raritan Bay Medical Center, Perth Amboy, New Jersey, USA
| | - Abdalla Yousif
- Department of Medicine, Raritan Bay Medical Center, Perth Amboy, New Jersey, USA
| | - Vladimir Rukshin
- Department of Medicine, Raritan Bay Medical Center, Perth Amboy, New Jersey, USA
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Kirchberger I, Meisinger C, Golüke H, Heier M, Kuch B, Peters A, Quinones PA, von Scheidt W, Mielck A. Long-term survival among older patients with myocardial infarction differs by educational level: results from the MONICA/KORA myocardial infarction registry. Int J Equity Health 2014; 13:19. [PMID: 24552463 PMCID: PMC3940020 DOI: 10.1186/1475-9276-13-19] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2013] [Accepted: 02/07/2014] [Indexed: 11/10/2022] Open
Abstract
Background Socioeconomic disparities in survival after acute myocardial infarction (AMI) have been found in many countries. However, population-based results from Germany are lacking so far. Thus, the objective of this study was to examine the association between educational status and long-term mortality in a population-based sample of people with AMI. Methods The sample consisted of 2,575 men and 844 women, aged 28–74 years, hospitalized with a first-time AMI between 1 January 2000 and 31 December 2008, recruited from a population-based AMI registry. Patients were followed up until December 2011. Data on education, risk factors and co-morbidities were collected by individual interviews; data on clinical characteristics and AMI treatment by chart review. Cox proportional hazards models were used to assess the relationship between educational status and long-term mortality. Results During follow-up, 19.1% of the patients with poor education died compared with 13.1% with higher education. After adjustment for covariates, no effect of education on mortality was found for the total sample and for patients aged below 65 years. In older people, however, low education level was significantly associated with increased mortality (hazard ratio (HR) 1.44, 95% confidence interval (CI) 1.05–1.98, p = 0.023). Stratified analyses showed that women older than 64 years with poor education were significantly more likely to die than women in the same age group with higher education (HR 1.57, 95% CI 1.02–2.41, p = 0.039). Conclusions Elderly, poorly educated patients with AMI, and particularly women, have poorer long-term survival than their better educated peers. Further research is required to illuminate the reasons for this finding.
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Affiliation(s)
- Inge Kirchberger
- Central Hospital of Augsburg, MONICA/KORA Myocardial Infarction Registry, Stenglinstr, 2, Augsburg D-86156, Germany.
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Wang JY, Wang CY, Juang SY, Huang KY, Chou P, Chen CW, Lee CC. Low socioeconomic status increases short-term mortality of acute myocardial infarction despite universal health coverage. Int J Cardiol 2014; 172:82-7. [PMID: 24444479 DOI: 10.1016/j.ijcard.2013.12.082] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2013] [Revised: 12/16/2013] [Accepted: 12/20/2013] [Indexed: 11/25/2022]
Abstract
BACKGROUND This nationwide population-based study investigated the relationship between individual and neighborhood socioeconomic status (SES) and mortality rates for acute myocardial infarction (AMI) in Taiwan. METHODS A population-based follow-up study included 23,568 patients diagnosed with AMI from 2004 to 2008. Each patient was monitored for 2 years, or until their death, whichever came first. The individual income-related insurance payment amount was used as a proxy measure of patient's individual SES. Neighborhood SES was defined by household income, and neighborhoods were grouped as advantaged or disadvantaged. The Cox proportional hazards model was used to compare the mortality rates between the different SES groups after adjusting for possible confounding risk factors. RESULTS After adjusting for potential confounding factors, AMI patients with low individual SES had an increased risk of death than those with high individual SES who resided in advantaged neighborhoods. In contrast, the cumulative readmission rate from major adverse cardiovascular events did not differ significantly between the different individual and neighborhood SES groups. AMI patients with low individual SES had a lower rate of diagnostic angiography and subsequent percutaneous coronary intervention (P<0.001). The presence of congestive heart failure, chronic kidney disease, chronic obstructive pulmonary disease, pneumonia, septicemia, and shock revealed an incremental increase with worse SES (P<0.001). CONCLUSIONS The findings indicate that AMI patients with low individual SES have the greatest risk of short-term mortality despite being under a universal health-care system. Public health strategies and welfare policies must continue to focus on this vulnerable group.
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Affiliation(s)
- Jen-Yu Wang
- Department of Internal Medicine, Cardinal Tien Hospital, School of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan
| | - Cheng-Yi Wang
- Department of Internal Medicine, Cardinal Tien Hospital, School of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan
| | - Shiun-Yang Juang
- Department of Medical Research, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan
| | - Kuang-Yung Huang
- School of Medicine, Tzu Chi University, Hualian, Taiwan; Division of Allergy, Immunology, and Rheumatology, Department of Internal Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan
| | - Pesus Chou
- Community Medicine Research Center and Institute of Public Health, National Yang-Ming University, Taipei, Taiwan
| | - Chih-Wei Chen
- School of Medicine, Tzu Chi University, Hualian, Taiwan; Division of Cardiology, Department of Internal Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan.
| | - Ching-Chih Lee
- School of Medicine, Tzu Chi University, Hualian, Taiwan; Community Medicine Research Center and Institute of Public Health, National Yang-Ming University, Taipei, Taiwan; Department of Otolaryngology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan; Department of Education, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan; Center for Clinical Epidemiology and Biostatistics, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan.
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Hofman A, Darwish Murad S, van Duijn CM, Franco OH, Goedegebure A, Ikram MA, Klaver CCW, Nijsten TEC, Peeters RP, Stricker BHC, Tiemeier HW, Uitterlinden AG, Vernooij MW. The Rotterdam Study: 2014 objectives and design update. Eur J Epidemiol 2013; 28:889-926. [PMID: 24258680 DOI: 10.1007/s10654-013-9866-z] [Citation(s) in RCA: 259] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2013] [Accepted: 11/08/2013] [Indexed: 02/06/2023]
Abstract
The Rotterdam Study is a prospective cohort study ongoing since 1990 in the city of Rotterdam in The Netherlands. The study targets cardiovascular, endocrine, hepatic, neurological, ophthalmic, psychiatric, dermatological, oncological, and respiratory diseases. As of 2008, 14,926 subjects aged 45 years or over comprise the Rotterdam Study cohort. The findings of the Rotterdam Study have been presented in over a 1,000 research articles and reports (see www.erasmus-epidemiology.nl/rotterdamstudy ). This article gives the rationale of the study and its design. It also presents a summary of the major findings and an update of the objectives and methods.
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Affiliation(s)
- Albert Hofman
- Department of Epidemiology, Erasmus Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands,
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Agyemang C, van Oeffelen AAM, Bots ML, Stronks K, Vaartjes I. Socioeconomic inequalities in acute myocardial infarction incidence in migrant groups: has the epidemic arrived? analysis of nation-wide data. Heart 2013; 100:239-46. [PMID: 24241713 DOI: 10.1136/heartjnl-2013-304721] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES We assessed socioeconomic inequalities in relation to acute myocardial infarction (AMI) incidence among major ethnic groups in The Netherlands. METHODS A nationwide register-based cohort study was conducted (n=2 591 170) between 1 January 1998 and 31 December 2007 among ethnic Dutch and migrant groups from Suriname, Netherlands Antilles, Indonesia, Morocco and Turkey. Standardised household disposable income was used as a proxy for socioeconomic position. Cox proportional hazard models were used to estimate the socioeconomic inequalities in AMI incidence. RESULTS Among ethnic Dutch, the AMI incidence was higher in the low-income group than in the high-income group: adjusted HRs were 2.05 (95% CI 2.00 to 2.10) for men and 2.33 (95% CI 2.23 to 2.43) for women. Importantly, similar socioeconomic inequalities in AMI incidence were also observed in all minority groups, with the low socioeconomic group having a higher AMI incidence than the high socioeconomic group: adjusted HR ranging from 2.07 (95% CI 1.26 to 3.40) in Moroccans to 2.73 (95% CI 1.55 to 4.80) in Antilleans in men; and from 2.17 (95% CI 1.74 to 2.71) in Indonesians to 3.88 (95% CI 2.36 to 6.38) in Turks in women. CONCLUSIONS Our findings demonstrate socioeconomic inequalities in AMI incidence in migrant groups and suggest a convergence towards the Dutch general population. If the AMI incidence rates of the low socioeconomic group could be reduced to the level of the high socioeconomic group, this would represent a major public health improvement for all ethnic groups.
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Affiliation(s)
- C Agyemang
- Academic Medical Center, University of Amsterdam, , Amsterdam, The Netherlands
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van Oeffelen AAM, Vaartjes I, Stronks K, Bots ML, Agyemang C. Sex disparities in acute myocardial infarction incidence: Do ethnic minority groups differ from the majority population? Eur J Prev Cardiol 2013; 22:180-8. [DOI: 10.1177/2047487313503618] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Aloysia AM van Oeffelen
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, The Netherlands
| | - Ilonca Vaartjes
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, The Netherlands
| | - Karien Stronks
- Department of Public Health, Academic Medical Centre, University of Amsterdam, The Netherlands
| | - Michiel L Bots
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, The Netherlands
| | - Charles Agyemang
- Department of Public Health, Academic Medical Centre, University of Amsterdam, The Netherlands
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van Oeffelen AAM, Vaartjes I, Stronks K, Bots ML, Agyemang C. Incidence of acute myocardial infarction in first and second generation minority groups: does the second generation converge towards the majority population? Int J Cardiol 2013; 168:5422-9. [PMID: 24035066 DOI: 10.1016/j.ijcard.2013.08.046] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2012] [Revised: 05/30/2013] [Accepted: 08/18/2013] [Indexed: 11/17/2022]
Abstract
BACKGROUND Differences in acute myocardial infarction (AMI) incidence between ethnic minority and migrant groups (henceforth, minority groups) and the majority population have been reported. Health differences may converge towards the majority population over generations. We assessed whether AMI incidence differences between minority groups living in the Netherlands and the Dutch majority population exist, and whether the incidence converges towards the majority population over generations. METHODS A nationwide register-based cohort study was conducted from 1997 to 2007. Using Cox Proportional Hazard Models AMI incidence differences between minorities and the majority population were estimated. When possible, analyses were stratified by generation. RESULTS AMI incidence differences between minorities and the majority population depended on the country of origin, and often varied between minorities originating from the same geographical region. For example, among North African and Mediterranean minorities, incidence was higher in Turkish (Hazard Ratio (HR): 1.34; 95% Confidence Interval (95% CI): 1.28-1.41), but lower in Moroccans (HR: 0.46; 95% CI: 0.40-0.52) compared with the majority population. Most minorities had a similar or lower incidence than the majority population, which remained similar or converged towards the incidence of the majority population over generations. In contrast, among minorities from the former Dutch colonies (Suriname, Indonesia, Netherlands Antilles) beneficial intergenerational changes were observed. CONCLUSIONS Health care professionals and policy makers should be aware of substantial AMI incidence differences between minority groups and the majority population, and the often unbeneficial change over generations. Future research should be cautious when clustering minority groups based on geographical region of the country of origin.
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Affiliation(s)
- A A M van Oeffelen
- Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, Netherlands.
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